Tan Xiang Li, Park Hyun, Patel Jasmine, Murden Matthew
Medicine, Ashford and St. Peter's Hospital NHS Foundation Trust, Chertsey, GBR.
Cureus. 2021 Oct 31;13(10):e19156. doi: 10.7759/cureus.19156. eCollection 2021 Oct.
Background National guidance stipulates the essential components of a safe handover. Shift-based work and the COVID-19 pandemic has led to an increased turnover and re-deployment of staff into new clinical areas, creating challenges in delivering effective handovers. Aim The aim of this quality improvement project (QIP) was to improve adherence to a local standardised handover proforma to improve the quality and consistency of handovers. Methods Handovers were assessed by measuring the completion rates of the essential components of a safe handover as outlined in the national guidance. Data were collected from an electronic handover system which follows the Situation, Background, Assessment and Recommendations (SBAR) structure, and percentage completion rates obtained for each component assessed. Following baseline measurement, four Plan-Do-Study-Act (PDSA) cycles were completed between August 2020 and February 2021 across two junior doctor rotations and during a COVID surge rota. Results A total of 710 handovers were assessed across the four PDSA cycles. There were overall improvements in the percentage completion rates of each component compared to baseline: Under 'Situation', admission dates increased by 13.7%, estimated discharge date by 33.3% and 100% completion rate maintained for the presenting complaint. Under 'Background', past medical history remained static, with a 12.1% increase in documentation of a social history. Under 'Assessment', escalation status increased by 335%, issues list by 242% and important updates by 35.2%. Under 'Recommendations', completion rate for plans was maintained at 100%. Conclusions Our findings demonstrated an overall improvement in the majority of components of the handover proforma. Challenges remain with the rotation of junior doctors through different specialties leading to a loss of institutional knowledge and reduced longevity of the intervention's effect, exacerbated by the introduction of the COVID surge rota. A long-lasting improvement may require a shift to a completely electronic patient records system (ePR) which incorporates a handover tool.
国家指南规定了安全交接班的基本要素。轮班工作以及新冠疫情导致员工更替增加，且员工被重新调配到新的临床领域，这给进行有效的交接班带来了挑战。
本质量改进项目（QIP）的目的是提高对当地标准化交接班模板的依从性，以提高交接班的质量和一致性。
通过衡量国家指南中概述的安全交接班基本要素的完成率来评估交接班情况。数据从遵循情况、背景、评估和建议（SBAR）结构的电子交接班系统中收集，并获得每个评估组件的完成率百分比。在基线测量之后，在2020年8月至2021年2月期间，针对两轮初级医生轮岗以及新冠疫情高峰期排班，完成了四个计划-执行-研究-行动（PDSA）循环。
在四个PDSA循环中，共评估了710次交接班。与基线相比，每个组件的完成率百分比总体上都有所提高：在“情况”部分，入院日期增加了13.7%，预计出院日期增加了33.3%，现病史的完成率保持在100%。在“背景”部分，既往病史保持不变，社会史记录增加了12.1%。在“评估”部分，升级状态增加了335%，问题清单增加了242%，重要更新增加了35.2%。在“建议”部分，计划的完成率保持在100%。
我们的研究结果表明，交接班模板的大多数组件总体上有所改进。由于初级医生在不同专科之间轮转，导致机构知识流失，干预效果的持久性降低，而新冠疫情高峰期排班加剧了这一情况，挑战依然存在。长期的改进可能需要转向一个完全集成了交接班工具的电子病历系统（ePR）。
